It has been almost three years since NHS England set out its vision to transform maternity services in the Better Births report.
That vision was, and still is, welcome and ambitious – we all want safe, kind, personal and professional services.
And yet the report made scant reference to the ways in which this vision would be achieved for women in the most difficult circumstances – those women with complex and multiple issues in their lives; who experience the greatest risks in pregnancy and birth, and the most barriers in accessing the support they really need.
This was surprising given the growing body of evidence that women facing multiple disadvantages experience poorer outcomes and are more poorly served in maternity services.
That’s why Birth Companions partnered with The Revolving Doors Agency to produce our latest research report: Making Better Births a Reality for Women with Multiple Disadvantages.
“Our report has provided a platform for 34 women to tell their stories”
Published last month, this research sought to understand the realities of the maternity system for women dealing with substance misuse; trauma and abuse; mental health issues; homelessness; disabilities; criminal justice or social services involvement; trafficking; significant financial needs; and other complicating factors.
Crucially, the research was conducted by women with experience of multiple disadvantages, trained as peer-researchers. Thanks to their insight and expertise, our report has provided a platform for 34 women to tell their stories; women whose voices are rarely heard by mainstream services.
So what did they tell us?
The overarching themes that emerged were illuminating and hugely motivating. Women described their fear and distrust of services, and strong desire to be asked more about their situations so they could be understood and supported in the right way.
They talked of the difference a swift response to problems and early, proactive referrals could make for them and their babies, and the importance of compassionate, non-judgemental care; continuity of carer and specialist midwifery support.
They explained the obstacles created by their financial hardship, like not being able to afford to eat three meals a day while pregnant and not having the money to take the bus home after an emergency admission to hospital.
They also told us of the high levels of trauma they experienced before and during their pregnancy. Perhaps most worry were the stories of women who had had their babies taken into care, who described the lack of preparation for and support after this most distressing separation.
“There is much to reassure and enthuse us in the research”
But it isn’t entirely bleak. There is much to reassure and enthuse us in the research. Where compassionate and skilled midwives effectively identified women’s needs and made swift referrals to appropriate services, the outcomes for women and their babies were markedly improved.
These issues are, by their very nature, complex, intertwined and often not identified. Yet, that doesn’t mean they are impossible to tackle. One way to make significant progress towards the Better Births vision for these women, and others, would be the adoption of a universal trauma-informed approach across the maternity system.
Becoming trauma-informed means creating a framework through which to promote a greater understanding of the needs and behaviours that often stem from a history of trauma, and the development of a range of new skills to equip staff to respond to these.
Such an approach would increase protection and responsiveness for those who have experienced trauma, which include so many of those with complex needs. A universally trauma-informed system would enable a protective approach to women who disclose trauma, and those whose trauma remains hidden.
This latest research with The Revolving Doors Agency has underlined both the challenges and the opportunities that the perinatal period represents for women facing severe disadvantage.
If NHS England is to translate Better Births into a reality for all, it must address both these aspects – the negatives and the positives – in a way that is fully mindful of these women, and directly informed by them.
That’s the power of peer-led research, and the potential of universally trauma-informed care.
Naomi Delap is director of Birth Companions, a charity working to support and improve outcomes for perinatal women facing severe disadvantage